HOSPITAL VS HOME-BASED EXERCISE REHABILITATION FOR PATIENTS WITH PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

Supervised, hospital-based exercise rehabilitation programs are effect ive for improving functional status for patients with claudication due to peripheral arterial occlusive disease. However, it has been sugges ted that unsupervised, home-based exercise programs, which have been r elatively little evaluated, would be equally efficacious as compared w ith hospital-based programs. The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise performance more than a home-based program. Of 20 consecutiv ely enrolled patients with claudication, 10 were randomly placed into a supervised, hospital-based program and 10 into an unsupervised, home -based program for a three-month period. Exercise performance was eval uated by treadmill testing using a graded protocol. In addition, funct ional status was evaluated by the Walking Impairment Questionnaire (WI Q) and the Medical Outcomes Study SF-20 questionnaire (MOS). Patients in the hospital-based program were treated with treadmill walking thre e times a week for one hour/visit. Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with the pro gram. Patients in the hospital-based group improved peak walking time by 137%, pain-free walking time by 150%, and peak oxygen consumption b y 19% (all P<0.05). Patients reported an improved walking distance and speed according to WIQ data (both P<0.05). In addition, the MOS physi cal functioning score in the hospital-based group improved by 20 perce ntage points (P<0.05). In contrast, patients in the home-based program did not improve exercise performance measured on the treadmill. Impro vement in the ability to walk on the treadmill was greater in the hosp ital-based than the home-based program (P<0.05). The ability to walk d istances was the only questionnaire measure that improved in persons w ho received the home-based program (P<0.05). Preliminary results sugge st that a supervised, hospital-based program is more effective for imp roving treadmill exercise performance than an unsupervised, home-based program.